Skip to content
Home
Our Clinic
Resources
Bookings
Reviews
Repeat prescriptions
Contact Us
ADHD Test
Home
Our Clinic
Resources
Bookings
Reviews
Repeat prescriptions
Contact Us
ADHD Test
DIVA symptom checklist
Modified DIVA Self-report: Symptom Checklist
This form checks for current and past ADHD symptoms in different areas of your life
Name
*
First
Email
*
A1. Do you often fail to give close attention to detail, or do you make careless mistakes in your work or during other activities?
*
Yes
No
A2. Do you often find it difficult to sustain your attention on tasks?
*
Yes
No
A3. Does it often seem as though you are not listening when you are spoken to directly?
Yes
No
A4. Do you often fail to follow through on instructions and do you often fail to finish jobs or fail to meet obligations at work?
*
Yes
No
A5. Do you often find it difficult to organise tasks and activities?
*
Yes
No
A6. Do you often avoid (or do you have an aversion to, or are you unwilling to do) tasks which require sustained mental effort?
*
Yes
No
A7. Do you often lose things that are needed for tasks or activities?
*
Yes
No
A8. Are you often easily distracted by external stimuli?
*
Yes
No
A9. Are you often forgetful during daily activities?
*
Yes
No
B1. Do you often move your hands or feet in a restless manner, or do you often fidget in your chair?
*
Yes
No
B2. Do you often stand up in situations where the expectation is that you should remain in your seat? This includes coffee or loo breaks that are not needed other than to move around.
*
Yes
No
B3. Do you often feel restless?
*
Yes
No
B4. Do you often find it difficult to engage in leisure activities quietly?
*
Yes
No
B5. Are you often on the go or do you often act as if “driven by a motor”?
*
Yes
No
B6. Do you often talk excessively?
*
Yes
No
B7. Do you often give the answer before questions have been completed?
*
Yes
No
B8. Do you often find it difficult to wait your turn?
*
Yes
No
B9. Do you often interrupt the activities of others, or intrude on others?
*
Yes
No
C1. Have you always had these symptoms of attention deficit and/or hyperactivity/impulsivity?
*
Yes
No
C2. In which areas do you have/have you had problems with these symptoms?
*
Select All
Education
Work
Social relationships
Family
GDPR Consent
*
I agree.
I agree that ADHD Consultancy may retain and use my personal information for the purpose of completing your report. We may also use your data in anonymised form in research assessing benefits of our ADHD treatments but this will not affect your confidentiality.
